Incomplete Expansion of Chimney Stent Graft during Chimney-Thoracic Endovascular Aneurysm Repair

Background To report a technical complication during a chimney-thoracic endovascular aneurysm repair (Ch-TEVAR) procedure. Methods A 77-year-old female patient underwent Ch-TEVAR for a symptomatic thoracic aortic aneurysm with a short and angulated proximal neck. Deployment of the aortic stent graft over the left subclavian artery (LSA) was followed by placement of a balloon-expandable covered stent as a chimney for the LSA. Results Chimney deployment failed due to balloon perforation. Additional attempts with several balloons all failed, albeit gaining some additional expansion of the chimney stent graft. The technical complication was solved by deploying a self-expanding bare stent inside the chimney stent. This enabled additional ballooning and further expansion of the chimney stent graft leading to an acceptable end result. Conclusions Ch-TEVAR with a balloon-expandable chimney stent graft can be complicated by incomplete chimney deployment due to balloon perforation. Relining of the chimney stent graft with a self-expanding stent improved the deployment with acceptable patency.